Alternative strategies of opiate detoxification: Evaluation of the so-called ultra-rapid detoxification

This study was done in order to examine the hypothesis that so-called ultra -rapid opiate detoxification provides a mild, short, and safe withdrawal. A total of 22 patients who were addicted to opiates exclusively underwent ul tra-rapid detoxification. Each patient was pretreated with methadone. Durin g general anesthesia lasting about six hours with methohexital or propofol, naloxone was administered with doubling of the dose every 15 minutes with a starting bolus dose of 0.4 mg. The total bolus dose of 12.4 mg, delivered within 60 minutes, was followed by a naloxone infusion of 0.8 mg/h until t he next morning. On the day of anesthesia naltrexone (50 mg/d) treatment wa s initiated. When withdrawal symptoms occurred, specific medications, e.g., clonidine, were added. After determining baseline values, withdrawal sympt oms were investigated during a further four weeks by means of established c linical scales. The results document marked withdrawal symptoms for at leas t one week after detoxification. The intensity of withdrawal symptoms durin g the first seven days of treatment was significantly (p<0.05) more marked than during baseline. None of the patients underwent a life-threatening com plication and only one patient failed to complete the detoxification proced ure. Finally, about 75% of the patients could be referred for further treat ment. In this study ultra-rapid detoxification provided a safe withdrawal p rocedure with high rates of completed withdrawals and referrals for further treatment, respectively. However, in contrast to previous reports, many pa tients suffered from middle-grade withdrawal symptoms over several days. Du e to the risks of general anesthesia and the expense associated with this t reatment, only patients addicted to opiates alone and for whom other detoxi fication strategies are unsuitable should undergo a ultra-rapid detoxificat ion procedure.